Koh D.-M.,Royal Marsden NHS Foundation Trust
Radiology | Year: 2014
In the study by Joo et al (1), perfusion-sensitive parameters derived from diffusion-weighted (DW) magnetic resonance (MR) imaging using intravoxel incoherent motion (IVIM) analysis were significantly decreased 4 hours after administration of a vascular disrupting agent (VDA) (CKD-516), in keeping with drug-induced vascular collapse. A larger decrease in the perfusion-sensitive IVIM parameters was correlated with smaller tumor size increase 7 days after treatment. © RSNA, 2014.
Farquhar-Smith P.,Royal Marsden NHS Foundation Trust
Current Opinion in Supportive and Palliative Care | Year: 2011
Purpose of review To discuss the importance, clinical features, possible pathology and treatments of chemotherapy-induced neuropathic pain. Newer biological agents such as bortezomib will be considered in greater detail. Recent findings Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent complication of common anticancer therapies. It may lead to treatment compromise, significantly adds to the symptom burden and interferes with quality of life of cancer survivors. Recent investigations have identified processes involved in CIPN which may give some insight for the development of novel treatments. CIPN induced by different anticancer therapies may be heterogeneous and present as distinct neuropathic pains. Recent work has focussed on the newer anticancer drugs such as bortezomib. Contemporaneous studies have failed to find good evidence for the use of several common antineuropathic agents and further research is required. Summary Painful CIPN remains under recognized and undertreated. It is an important cause of pain during cancer treatment and is a common pain in the cancer survivor. Difficulties in assessment and limitations in treatment contribute to management problems. Improvements in education (patient and clinician), assessment and treatment would potentially reduce the often debilitating effects of painful CIPN. 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Muls A.C.,Royal Marsden NHS Foundation Trust
Acta Oncologica | Year: 2014
Background. The percentage of people living with a diagnosis of cancer is rising globally. Between 20% and 25% of people treated for cancer experience a consequence of cancer which has an adverse impact on the quality of their life. Gastrointestinal (GI) symptoms are the most common of all consequences of cancer treatment and have the greatest impact on daily activity. Pathophysiology of long-term bowel damage after pelvic radiotherapy. Long-term damage to the bowel after radiotherapy is mediated by ischaemic changes and fibrosis. Each fraction of radiotherapy causes a series of repetitive injuries to the intestinal tissue resulting in an altered healing process, which affects the integrity of the repair and changes the architecture of the bowel wall. The nature of GI symptoms that develop. Patient-reported outcome measures show that diarrhoea, urgency, increased bowel frequency, tenesmus and flatulence are the five most prevalent GI symptoms with a moderate or severe impact on patients' daily lives after treatment with pelvic radiotherapy. Many patients also experience fatigue, urinary problems and have sexual concerns. Systematic assessment and management. The complex nature of those symptoms warrants systematic assessment and management. The use of a tested algorithm can assist in achieving this. The most common contributing factors to ongoing bowel problems after pelvic radiotherapy are small intestinal bacterial overgrowth, bile acid malabsorption, pancreatic insufficiency, rectal bleeding and its impact on bone health. The wider context. Symptom burden, socio-psychosocial impact, memory and cognitive function, fatigue, urinary problems and sexual concerns need to be taken into account when thinking about consequences of cancer treatment. Conclusion. As our understanding of consequences of cancer treatments continues to emerge and encompass a wide variety of specialties, a holistic, multifaceted and multidisciplinary approach is required to manage those consequences long-term. © 2014 Informa Healthcare.
Fisher C.,Royal Marsden NHS Foundation Trust
Virchows Archiv | Year: 2010
Many soft tissue sarcoma subtypes have consistent chromosomal translocations with novel fusion genes, which result in disordered cellular function. The microscopic appearances, immunophenotype and behaviour of such tumours relate to the genetic events to a variable extent. This paper reviews the molecular pathology and related morphological and clinical features of sarcomas with non-EWS translocations. These include synovial sarcoma, alveolar rhabdomyosarcoma, alveolar soft part sarcoma, dermatofibrosarcoma protu-berans, low-grade fibromyxoid sarcoma, infantile fibro-sarcoma and inflammatory myofibroblastic tumour. © Springer-Verlag 2010.
Escudier B.,Institute Gustave Roussy |
Gore M.,Royal Marsden NHS Foundation Trust
Seminars in Oncology | Year: 2013
The sequencing of targeted therapy is well established in metastatic renal cancer. Switching between different vascular endothelial growth factor (VEGF)-targeted therapies or VEGF-targeted therapies and mammalian target of rapamycin (mTOR) inhibitors are both of proven benefit. The optimal sequence remains unclear. Unfortunately, there is a lack of biomarkers to drive decision making. In this article we review the current data and describe the treatment options for patients. © 2013 Elsevier Inc.